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Objectives. To develop and implement a competency-based assessment process for the experiential component of a pharmacy education curriculum. Design. A consultative process was used in the development of new assessment forms and policies, and a survey regarding student and faculty satisfaction was conducted. Information received from the survey and from consultations with faculty preceptors resulted in revision of the forms in subsequent years. Assessment. Faculty and student perceptions of the assessment process were generally positive. We were moderately successful in reducing grade inflation. The new process also provides the school with data that can be used to evaluate the effectiveness of our curriculum in preparing students for practice. Conclusions. Development and implementation of a competency-based assessment process require a considerable amount of work from dedicated faculty members. With health professions schools under pressure to provide evidence of their graduates' clinical competence, this is a worthwhile investment.

It's been called the silver tsunami, the age wave, the geriatric imperative, among others. It is the aging baby boomers and the first of this cohort turns 65 years old in 2011. From a health care perspective, the numbers are scary. Seventy-six million boomers will enter the fragmented, under funded health care arena for older people. Today the elderly constitute 12% of the US population and use approximately 35% of all medications. Medication use will likely grow with increased use of multiple medications to treat illnesses and increase longevity. Over the next 20 years, 1 in every 5 Americans will be over 65 years of age, and even more important, the 85-plus cohort will expand to 15 million over the next 40 years-about the same length of time that our recent graduates will be in practice. This raises the question: Are our graduates able to provide excellent care to the ever increasing older population? Older people, particularly those more than 85 years old, utilize massive healthcare dollars, have the poorest outcomes from adverse drug events (ADEs), and often receive inadequate, inappropriate, or poorly managed medication therapy.The incidence of avoidable adverse outcomes from drug therapy in older people is shameful. For example, 28% of ADEs in ambulatory geriatric patients are deemed preventable; even more shocking, 50% of the life-threatening and fatal ADEs are preventable.1 Why aren't they being prevented? Who's responsible for prevention? The main causes of these preventable ADEs include prescribing inappropriate medications, wrong dosing, and inferior monitoring. Poor patient adherence and lack of patient education account for more than 20% of preventable ADEs 1 -clearly a pharmacist intervention opportunity. In older adults the incidence of emergency department visits as a consequence of ADEs increases with age and accounts for 25% of all ADE-related emergency department visits.2 Improper therapeutic monitoring is a major cause for these visits, and approximately 50% of seniors with drug-related emergency department visits are hospitalized as a result of their ADE, highlighting the vulnerability of older people using medications.2 Given these and other alarming data, what is going to happen over the next 20 years when our population is 20% geriatric? Will pharmacists be on the front lines rendering better care in the future than what is currently being provided?The Institute of Medicine's 2008 report, Retooling for an Aging America: Building the Health Care Workforce, makes the case that ''the geriatric competence of virtually all members of the health care workforce needs to be improved through significant enhancements in the educational curricula and training programs.'' 3 Like most health disciplines, pharmacy education is woefully inadequate in geriatrics. Few US colleges and schools of pharmacy mandate a geriatric-focused advanced practice experience, although most schools offer this as an elective. 4,5 In addition, few pharmacy schools have a required geriatrics course or module and integrate ge...

Adverse drug events (ADEs) are all too common in older patients. Although there are multiple causes for the ADEs in the elderly, alterations in pharmacokinetics (PK) and pharmacodynamics (PD) are frequent culprits. These alterations in PK and PD may be part of the normal aging process. Older patients often develop significant drug-related problems when alterations in PK and PD are not appropriately accounted for in prescribing and monitoring of medications. Clinically, the most significant PK changes that occur in aging are renal elimination and metabolism of drugs. In general, renal function declines with aging, necessitating dosage adjustments for drugs with renal-elimination pathways. The ability of the liver to metabolize certain drugs may also decline as a consequence of the aging process. From a PD standpoint, exaggerated responses are frequent, and often it is the side effects of medications that become exaggerated, rather than the therapeutic effects. Drugs affecting the central nervous system are particularly prone to PD alterations. Because of the PK and PD changes, vigilant monitoring of both therapeutic and adverse effects is mandatory in older patients. Based on PK and PD differences between middle-aged and elderly patients, there are certain medications that should almost always be avoided in older people. In addition, because older people tend to use more medications, the incidence of drug-drug interactions becomes more prevalent. Most of the drug-drug interactions that adversely impact older people involve both PK and PD mechanisms. Pharmacists and all prescribers must have a sound understanding of PK and PD effects of medications used in older people to provide optimal care and avoid preventable drug-related problems.

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